Test Of Functional Health Literacy Research Articles

Effects of health literacy and cognitive abilities on COPD self-management behaviors: A prospective cohort study.

Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95% CI, 1.02-2.08), correct MDI (OR 1.66; 95% CI, 1.13-2.44) and DPI (OR 2.17; 95% CI, 1.30-3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.

Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure

ObjectivesTo test concurrent validity and acceptability of the Single Item Literacy Screener (SILS), Test of Functional Health Literacy (S-TOFHLA) and the Newest Vital Sign (NVS) in hospitalized adults with heart failure (HF). BackgroundHealth literacy is not routinely evaluated in adults hospitalized with HF. Low health literacy is linked to poor HF self-care and hospital readmissions. MethodsSILS, NVS and S-TOFHLA were completed by 85 patients with HF. Measures were examined for internal consistency reliability and acceptability. The NVS and S-TOFHLA were correlated with the SILS to establish concurrent validity. ResultsThe NVS (α = 0.70) and S-TOFHLA (α = 0.88) were reliable. The SILS significantly correlated with the S-TOFHLA (r = −0.308). The S-TOFHLA (M = 6.16) and NVS (M = 6.10) were acceptable measures. ConclusionThe S-TOFHLA and NVS were reliable and acceptable measures of health literacy in hospitalized HF population. The SILS correlated with the S-TOFHLA and may predict low health literacy when hospitalized. NVS total scores in this population aligned with the recent NAAL survey. Hospitalized adults with HF agreed to share the health literacy scores with their providers.

Adult Functional Health Literacy and its Related Factors: A Cross-Sectional Study

Background and aims: Health literacy (HL) can affect individual health, health communication and error in taking medicine. The aim of this study was to determine the level of HL and associated factors among Iranian adults. Methods: In this cross-sectional study, 240 participants over 18 years of age referring to health centers in Hamadan, west of Iran in 2015 were selected by multistage random sampling. HL was assessed by the Test of Functional Health Literacy in Adults (TOFHLA). The questionnaire was completed by a trained interviewer. The independent variables were structural and intermediate social factors based on the Commission on Social Determinants of Health (CSDH). Data were analyzed by using IBM SPSS version 22. Results: Average age of the participants was 30.88 ±7.38 years and 75.4% of the them were female. The total score of HL was 64.58 ±16.71 (range: 23.82-98.98). Overall, 31.7% (n=76) of the participants had adequate HL level, 32.5% (n=78) had borderline HL level and 35.8% (n=86) had inadequate HL level. Additionally, participants with higher educational levels had higher HL scores than those with lower educational levels (P<0.001). HL score was significantly higher in males than in females (P=0.017). Conclusion: HL level seems to be inadequate among Iranian adults in the west of Iran. Moreover, enhancing social determinants such as educational level seems to increase HL. The results highlighted the necessity for change and improvement in adults’ HL.

Measurement of health literacy in patients with cardiovascular diseases: A systematic review.

While many instruments have been developed, validated, and used to assess health literacy skills, their use and appropriateness among patients with cardiovascular diseases (CVDs) are not widely studied. To identify, appraise, and synthesize available health literacy assessment instruments used in patients with CVDs. Electronic databases were searched for studies that used validated measures to assess health literacy in patients with CVDs. Included studies were assessed for risk of bias and the identified instruments were evaluated based on their psychometric properties. Data were synthesized using a narrative approach. Forty-three studies were included in the review, of which 20 were cross-sectional studies and 12 were randomized controlled trials. Eleven health literacy assessment instruments were identified, of which only one was disease-specific. The Abbreviated version of the Test of Functional Health Literacy in Adults (S-TOFHLA) (n = 19) and the Rapid Estimate of Adult Literacy in Medicine (REALM) (n = 13) were found to be the most commonly used instruments to assess health literacy in CVDs. The S-TOFHLA and the REALM are the most widely used instruments to evaluate health literacy in CVD population. More CVD-specific health literacy screening instruments are warranted. Assessment of health literacy should be a standard of care in patients with CVDs and effective interventions should be developed to improve the impact of limited health literacy on health outcomes in this population.

Assessment of health literacy in the adult population registered to family medicine physicians in the Republic of Srpska, Bosnia and Herzegovina

Background: Health literacy is an important determinant of health. This concept is under-researched in the Republic of Srpska, Bosnia and Herzegovina.Objectives: To assess health literacy and its association with sociodemographic variables, self-perception of health and the presence of chronic conditions in primary healthcare setting.Methods: In May 2016, a cross-sectional study was executed in two primary healthcare centres. Out of approximately 1500 patients who visited both health centres during four consecutive days, about 800 were eligible. Of these, 110 patients agreed to complete the translated Short Test of Functional Health Literacy in Adults (S-TOFHLA). The influence of demographic, social, economic, and health characteristics (independent variables) on the S-TOFHLA score (dependent variable) was assessed by multiple logistic regression analysis.Results: One questionnaire was incomplete and therefore 109 questionnaires were analysed. Inadequate, marginal, and adequate health literacy were present in 19 (17.4%), 16 (14.7%) and 74 (67.9%) respondents. Adequate health literacy was found predominantly among respondents younger than 55 years and those with a high level of education. Regression analyses showed that low level of education (OR: 5.3), age 55 years and over (OR: 3.9), living in a rural area (OR: 3.7) and having three or more chronic diseases (OR: 2) were independently associated with inadequate or marginal health literacy.Conclusion: In this study performed in two primary healthcare centres in the Republic of Srpska, Bosnia and Herzegovina, low health literacy was associated with low level of education, older age, living in a rural area, and having more chronic diseases.

Test of health Literacy for Portuguese-speaking Adults.

Health literacy has been evaluated in several countries by tools developed for local language and culture. This study aimed to adapt and to validate the Health Literacy Test (TLS) for the Brazilian Portuguese language based on the Test of functional health literacy in adults (TOFHLA). The TLS, translated and adapted to the Brazilian scenario based on the Test of functional health literacy in adults, was administered to 302 users of a clinic of a University in Santa Catarina from September to October 2013. Cronbach's Alpha coefficient, Spearman's correlation and Analysis of Variance were used to assess the internal consistency, the correlation between the parts of the test and association between sociodemographic variables and the score of the Test, respectively. The average score of the test was 72,2, and 54.6% of participants had adequate health literacy, 19.2% had marginal health literacy and 26.2% had inadequate health literacy. The average score of the test was inversely related to the age of the participants and directly related to the level of education. There was no significant difference in the other sociodemographic characteristics. The internal consistency (Cronbach's alpha) was 0.953. The coefficients for the numerical and reading passages were 0.808 and 0.951, respectively. All the sections correlated positively and significantly with the Test, and also with each other. The validation of this test provides a new instrument to determine the literacy level in Brazilian adults.

Assessment of functional health literacy in Brazilian carers of older people.

ABSTRACT.Individuals with low health literacy have less knowledge of their own health condition. Carers play a key role in older people’s activities of daily living.Objective:to evaluate the performance of carers of older people using the S-TOFHLA (Short Test of Functional Health Literacy in Adults) and to identify caregiver characteristics associated with low functional health literacy.Methods:a cross-sectional study was conducted. The S-TOFHLA, a sociodemographic instrument, the Mini-Mental State Exam and the Patient Health Questionnaire-2 were applied to 80 carers of older patients routinely followed by doctors from the Primary Health Care Sector of the City of Botucatu, São Paulo. The multivariate analysis used an ordinal logistic regression model with test (S-TOFHLA) scores as the dependent variable. The level of statistical significance adopted was 0.05.Results:the individuals had a mean age of 54.6 (± 11.7); 27% of the carers evaluated had inadequate levels of health literacy (S-TOFHLA ≥54). A higher proportion of individuals with low education had inadequate or marginal health literacy (p<0.001).Conclusion:nearly 1/3 of the carers had marginal or inadequate levels of health literacy. These results highlight the difficulties of many carers in understanding health information.

Instruments used to evaluate functional health literacy in elderly persons with chronic kidney disease: Integrative review

Abstract Objective: To identify the instruments used to evaluate the functional health literacy of elderly persons with chronic kidney disease, and to assess whether they are suitable for this population. Method: An integrative review of the Lilacs, PubMed, Ibecs, Scopus and Cochrane databases was carried out in July and August 2018, seeking original articles dealing with functional health literacy and chronic kidney disease in the elderly. Results: A total of 15 articles were evaluated and seven different instruments used in the research were identified, with the Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults (TOFHLA) the most prevalent. Conclusion: The instruments identified are applicable for the elderly, but are not specific for this population. The construction and/or adaptation of new instruments is suggested considering the specific characteristics of this age group.

Health literacy and adherence to drug treatment of type 2 diabetes mellitus

ABSTRACT Objective: To analyze the relationship between health literacy and medication adherence of patients with Type 2 Diabetes Mellitus. Method: Quantitative cross-sectional study developed in five Family Health Strategies in the city of Picos, Piauí. Participants comprised 78 users of health services. The “Short Test of Functional Health Literacy in Adults” and the “Treatment Adherence Measurement Test” forms were applied to obtain sociodemographic variables. Descriptive and inferential statistical analysis. Results: Regarding health literacy, 51.3% of the participants were considered inadequate, and 87.2% were adherent to the drug treatment. The average of health literacy varied according to the level of medication adherence and sociodemographic variables. Conclusion: Most patients reported to adhere to the medication. Implications for practice: This study identified the health literacy and medication adherence profile of the patients, thus subsidizing the planning of nursing interventions in the attention of diabetes mellitus.

Correlates of Health Literacy Among Polish Immigrants With Chronic Health Conditions: Preliminary Results.

The rapid increase in immigration to the United States in the past decades has resulted in an influx of individuals who have to familiarize themselves with a completely new health care system and practices, often in a new language. The purpose of this study was to assess health literacy and investigate its correlates among older U.S. Polish immigrants living in the Greater Chicago area. We conducted a cross-sectional study on 60 older adults (24 men, 36 women; mean age = 71.1 years) who completed the Short Test of Functional Health Literacy (S-TOFHLA) and a demographic survey. Scores on S-TOFHLA were lower among older and less-educated immigrants. Undocumented immigrants reported using health care services less frequently than those with legal status. These results confirm the findings of previous studies that older age and fewer years of education are associated with inadequate health literacy. Being familiar with at least the basic information about one’s condition will help patients to better understand a diagnosis, manage their symptoms, and improve any preventive treatment. The findings emphasize the importance of health education among older Polish immigrants. More research employing diverse groups of immigrants is needed to better understand the factors associated with health literacy.

Letramento funcional em saúde e o conhecimento dos doentes renais crônicos em tratamento conservador

Objective: To evaluate the level of functional health literacy and knowledge about chronic kidney disease (DRC) in patients under conservative treatment. Methods: This is a cross-sectional, descriptive, and quantitative study carried out in a public reference hospital in Pernambuco, Brazil, in 2018. The sample, non-probabilistic for convenience, included 34 patients in the outpatient follow-up of DRC with conservative treatment. The following instruments were applied: sociodemographic questionnaire, clinical profile, questionnaire on the knowledge of the basic principles in the conservative treatment of DRC, and the B-TOFHLA test (Brief Test of Functional Health Literacy in Adults), to evaluate the level of functional health literacy (LFS). Results: It was found that the knowledge of 85.3% (n = 29) of the participants is sufficient concerning the basic principles of conservative treatment of DRC. Regarding the LFS, the inadequate level was prevalent in 14.7% (n = 5) of the participants. Regarding the association of the influence of literacy on knowledge about the treatment of DRC, there was greater knowledge in the group with adequate literacy (90.0%; n = 9), while in the group with inadequate literacy (borderline), the prevalence of sufficient knowledge was 83.3% (n = 20). It was also observed that, in addition to education, religion is also statistically relevant (p = 0.003; p = 0.048) for the adequate level of FHL in the studied group. Conclusion: Participants with DRC under conservative treatment obtained an inadequate level of functional health literacy and sufficient knowledge about the disease and treatment. These findings referring to knowledge point out that just transferring it to users is not enough for decisions that involve self-management of health.

Effects of Diabetic Foot Care Education for the Aged with Low Health Literacy

Purpose: The purpose of this study was to examine the effects of diabetic foot care education for the older adults with low health literacy. Methods: A quasi-experimental design with a non-equivalent control group pretest-posttest was used. The participants who were diagnosed with diabetes, were adults over 65 years old at the welfare center of Y and B city. They were divided into the experimental group (n=32) and the control group (n=31). Inclusion criteria were a score of 5 or under on the Short form of Korean Functional Health Literacy Test and 24 or more on the Korean version of Mini-Mental State Examination. Foot care education was conducted in a small group for 40 minutes, once a week, for three weeks. The education materials are composed of an easy term, picture and photographs to understand easily. Results: The scores of diabetic foot care knowledge (t=4.57, p<.001), foot care self-efficacy (t=6.07, p<.001), and foot self-care behavior (t=4.18, p<.001) were significantly increased in the experimental group compared to the control group. Foot health status was not significantly improved. Conclusion: The findings indicate that this education program can be used as a nursing intervention improving foot care knowledge, foot care self-efficacy, and foot self-care behavior in order to prevent the diabetic foot problems of elderly diabetic persons with low health literacy.

Are college students health literate?

Objective: To examine the health literacy of college students. Participants: A convenience sample of 245 graduate and undergraduate college students. Methods: During February–April of 2018 participants completed the Short Test of Functional Health Literacy which assessed literacy on two passages describing a thyroid scan, and basic healthcare insurance information. Results: Most college students displayed adequate health literacy (99.2%). The ANOVA analyses revealed college classification was the most significant predictor, followed by ethnicity, sex, and primary language. Age was significantly related to health literacy, when holding college classification constant. Interestingly, college major, healthcare work experience, or having health care credentials were not predictors of health literacy. Conclusion: This group of college students had adequate health literacy skills. However, the results of this study revealed demographic disparities that suggest further study.

Health Literacy in Women Presenting to a Urogynecology Practice

Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition. We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition. Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post-high school reading levels (70.1% vs 33.3%, P < 0.001). Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.

Health Literacy and Attention to Cigarette Health Warning Labels among Rural Smokers.

We evaluated the association of health literacy and attention to the pictorial imagery of 9 health warning labels (HWLs) in a tobacco advertisement among rural US smokers. We hypothesized that lower health literacy would be associated with greater visual attention to pictorial portions of HWLs and evaluated the association between health literacy and recall of advertisement elements. Adult smokers from Appalachian Ohio (N = 180) viewed a pictorial HWL encompassing 20% or 33% of a cigarette advertisement while eye tracking software recorded eye movements toward the advertisement. Health literacy was measured with The Short Test of Functional Health Literacy in Adults. Generalized linear regression revealed that every one-unit decrease in health literacy increased viewing time of the pictorial portion of the health warning label by 1.3 percentage points. Logistic regression revealed that the odds of recalling elements of the pictorial portion of the health warning label increased 20% for every one-unit increase in health literacy. Rural smokers with lower health literacy view pictorial portions of health warning labels longer than those with greater health literacy supporting that health literacy is an important consideration in health communications, including future cigarette warning labels.

Effects of Media Sensationalization on Cognitive Performance and Post Concussive Symptoms.

The current study aimed to examine if televised media about mild traumatic brain injury (mTBI) framed in a sensationalized manner had a negative impact on cognitive functioning and persistent mTBI symptoms. One hundred two participants (M Age=37.16; SD=22.61) with a history of post-acute mTBI, recruited through a community research registry and an undergraduate recruitment system, were included in this study. Participants were assessed with a measure of health literacy, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), and randomized to watch either a sensationalized or non-sensationalized news clip focused on mTBI. They were then assessed with the Paced Auditory Serial Addition Test (PASAT), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Patient Reported Outcome Measures Information System (PROMIS) Depression scale, and the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders 5th edition (PCL-5). Bayesian analyses indicated that sensationalized media-alone (β PASAT=-0.08; β RPQ=-0.08) or in the context of covariates (β PASAT=-0.11; β RPQ=-0.14)-was not a strong predictor of PASAT score or post-concussion syndrome symptom severity. Although media sensationalization of mTBI symptoms is not desirable, this study suggests that one brief exposure to sensationalized information may not have a meaningful immediate impact on the cognitive functioning or symptom reporting of individuals with a history of mTBI. Future research should examine long-term and downstream effects of sensationalized media reporting in samples with greater diversity of TBI history. (JINS, 2019, 25, 90-100).

Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments.

Background:Health literacy is an essential predictor of health status, disease control and adherence to medications.Objectives:The study goals were to assess the health literacy level of the general population in Saudi Arabia using translated Gulf Arabic version of the short-version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Single Item Literacy Screener (SILS) tests and to measure the relationship between health literacy and education level.Methods:The study was a cross-sectional with a convenience sample of 123 participants from the general population in Riyadh. Data were collected using the modified (Gulf) Arabic versions of both S-TOFHLA and SILS. Fisher’s Exact test was used to measure the difference of the health literacy scores according to the education degrees and Cronbach’s alpha was used to measure the internal consistency of the S-TOFHLA items.Results:More than half (55.4%) of the participants were male, 50.4% had a middle school or less education level, and we found that 84.4% had adequate health literacy as measured by the S-TOFHLA, compared to 49.6% as measured by SILS. The Fisher’s Exact test showed a significant difference (P<.05) in the S-TOFHLA and SILS scores according to education categories.Conclusions:The level of education has a significant positive association with S-TOFHLA and SILS results. The Gulf Arabic version of S-TOFHLA is a reliable test with a good internal consistency and a significant positive correlation between the two parts of S-TOFHLA. We recommend the use of S-TOFHLA or SILS at the first patient visit.

The Relationship of Health Literacy with Hypertension Self-Efficacy and General Self-Efficacy Among Schoolteachers

Background: Health literacy and self-efficacy are two key factors behind a wide variety of health-related outcomes. Objectives: This study aimed to examine the relationship of health literacy with hypertension self-efficacy and general self-efficacy. Methods: This cross-sectional descriptive-analytical study was conducted in 2016. Study sample consisted of 202 schoolteachers who were randomly selected from elementary and secondary schools in Qaenat county, Iran. Participants provided informed consent for participation and personally completed a demographic questionnaire, the short test of functional health literacy in adults, Sherer’s general self-efficacy scale, and Mularcik’s hypertension self-efficacy scale. The SPSS program (V. 19.0) was employed for data analysis through running the independent-sample t, Chi-square, Tukey’s post hoc tests, Pearson correlation analysis, and one-way analysis of variance at a significance level of less than 0.05. Results: The means of participants’ health literacy, hypertension self-efficacy, and general self-efficacy were 26.8 ± 7.5, 47.9 ± 11.5, and 38.1 ± 8.9, respectively. Most participants had adequate health literacy (77.2%) and high hypertension self-efficacy (71.3%), while only 9.9% of them had high general self-efficacy. There was a significant negative relationship between general self-efficacy and educational level. Moreover, health literacy had a significant negative correlation with age (r = -0.17; P = 0.013) and significant positive correlations with hypertension self-efficacy (r = 0.26; P = 0.001) and general self-efficacy (r = 0.15; P = 0.04). Conclusions: Health literacy has significant relationships with hypertension self-efficacy and general self-efficacy. Therefore, educational interventions can be used to improve health literacy, promote hypertension self-efficacy and general self-efficacy, and facilitate hypertension management.

EHealth Literacy in People Living with HIV: Systematic Review.

BackgroundIn the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome.ObjectiveThe objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH.MethodsThis systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable.ResultsWe identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed.ConclusionsUnderstanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures.

Role of cognitive ability in the association between functional health literacy and mortality in the Lothian Birth Cohort 1936: a prospective cohort study

ObjectivesWe investigated the role that childhood and old age cognitive ability play in the association between functional health literacy and mortality.DesignProspective cohort study.SettingThis study used data from the Lothian Birth...